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Start the day excited to make a difference...end the day knowing you did. Come join our team.
Job Summary:
EPIC Payor Reimbursement Analyst must have strong proficiency and knowledge application of providing analytic expertise in the following areas: Epic HB/PB contract build and modeling functions, healthcare financial and payor software systems, payor financial impact/trend analysis reports and managed care contracting knowledge. This role will require extensive knowledge of internal financial systems, ability to manipulate/present a wide data range upon request and understanding of financial impacts of managed care contracting to organization budgets. This position must demonstrate a commitment of quality service to our patients, the community, and our internal/external customers.
***At this time, this position is open to candidates located in and authorized to work in the United States who reside in one of the following states: VA, NC, SC, GA, FL, NE, TX, WI, LA, ME, WV, TN, LA, NH, IA and OH*** Essential Functions & Responsibilities Epic HB Resolute Function:
- Understanding and analysis of contracts, components, component groups, selection extensions, pricing extensions, hospital billing rules and many more items within the resolute
- Interpretation and loading of multiple fee schedules used within HB contracting
Epic PB Resolute Function:
- Interpretation and loading multiple fee schedules used within PB contracting
Epic HB/PB Resolute Function:
- Optimization of previously built contracts and creation of "new" contracts within the epic Contract Maintenance
- Build contracts within Epic that reimburse by DRG, percentage of billed charges, grouper rates, case rates, global case rates, per diem and contain lesser of and stop bill language, for utilization in expected reimbursement calculations
- Analyze, build, test, deploy and maintain Payor Relations contracts/fee schedules and system related functions
- Monitor, analyze and test interface projects and upgrades to ensure contract pricing and language are appropriate
- Utilizes contract modeling/cost accounting software to analyze/model the impact of contract rate proposals between MWHC and Payors
- Maintain knowledge in technical workflow and identify/communicate trends
Payor Relations Function:
- Analyzes and produces payor financial impact analysis for all contract proposals for HB/PB
- Performs retrospective impact analysis against organization budget to ensure contractual financial results meet set financial targets
- Analyzes the reimbursement impact of changes in government regulations, regulatory code changes/deletions/revisions, key managed care contracts, and third-party billing policies or requirements and reports financial impact to Manager.
- Utilize Excel to do the data analysis; data comes from Epic
- Performance of other duties assigned
Qualifications and Certifications: Required
- Minimum 3 years relevant experience
- Certified in applicable Epic application and/or certified within six months of hire
- Strong understanding of payor reimbursement coding (e.g., DRG, CPT, RC, HCPCS, OPPS, APC)
- Strong understanding of HB/PB workflows, analytics and technology
- Ability to prioritize multiple projects
- Strong verbal, written and presentation skills
- Ability to maintain professionalism and work within a team environment across multiple disciplines and teams
Preferred
- Certified in Healthcare Financial Professional (CHFP)
- Strong understanding of HB/PB revenue cycle functions and payor contracting
- Strong computer skills relevant to position; extensive experience using Excel, Access Database, knowledge of Lawson and Siemen's systems and DSS/Managed Care contract modeling software
As an EOE/AA employer, the organization will not discriminate in its employment practices due to an applicant's race, color, religion, sex, sexual orientation, gender identity, national origin, and veteran or disability status.
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Mary Washington Healthcare
Mar 13, 2025